Assessment Form Canada

ClientInformation/Assessment Form – Canada Express Entry

Type of Visa you are interested in: Student, Visitor, Work, Express Entry

First Name:
Last Name:
Current Address:
Phone Number:
Email:
Country of Citizenship:
Country of Current Residence:
Date of Birth:
Marital Status(please circle):
Single / Married

If Married, Date of Marriage:
Name of Dependent Date of Birth Relationship Occupation (if applicable) Wants to accompany (Yes/No)

Educational Details:

Name of Qualification Date of Birth Commencement Year Completion Year Grade/Percentage

Canadian Qualification: (if applicable)

Name of Qualification Date of Birth Commencement Year Completion Year Grade/Percentage

Work Experience:

Joining date Relieving date Organization Designation Main job duties

Canadian Work Experience:

Joining date Relieving date Organization Designation Main job duties

IELTS Score, if available Name of Test:____________ Date of Test:____/____/________

Reading Writing Listening Speaking Overall

French Language Score:

Reading Writing Listening Speaking Overall

Do you have any relative in Canada, if yes, please provide following details of the relative

Name Relation Visa status Occupation State/Territory of residence

Do you have a job offer from a Canadian Employer?

Name of Employer Job Position Job duties Start Date on Employment

Partner (Spouse) Skills & Qualification: Please complete if applicable
Partner work experience details:

Joining date Relieving date Organization Designation Main job duties

Partner educational details:

Name of Qualification University/Board Commencement Year Completion Year Grade/Percentage

Partner IELTS Score, if availableName of Test:___________ Date of Test:____/____/______

Reading Writing Listening Speaking Overall

French Language Score:

Reading Writing Listening Speaking Overall

Any other information you wish to provide:



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